Provider First Line Business Practice Location Address:
24923 HIGHSPRING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321-3461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-284-6258
Provider Business Practice Location Address Fax Number:
661-260-2979
Provider Enumeration Date:
03/08/2007